Bethany E Butler Prater, AU.D.
Individual provider Active NPI Audiologist · Fort Stewart, GA
NPI 1447249446 · NPPES record last updated Sep 29, 2020
Key facts
- NPI
- 1447249446
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- License
- AP1518 (ME)
- Practice address
- 1061 Harmon Ave Suite 1D03
CDR USA Meddac Credentials Office
Fort Stewart, GA 31314-5674 - Phone
- (912) 435-6633
- NPI assigned
- Oct 21, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP1518 | ME | MD | Audiologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | AP1518 | ME | Yes |
Addresses
Primary practice location
1061 Harmon Ave Suite 1D03
CDR USA Meddac Credentials Office
Fort Stewart, GA 31314-5674
Mailing address
1061 Harmon Ave Suite 1D03
CDR USA Meddac Credentials Office
Fort Stewart, GA 31314-5674
Phone (912) 435-6633
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 047949 | Other | ME | ANTHEM |
| 431784799 | Medicaid | ME |
Other providers in Fort Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.